The project will develop a palliative care benefit for the Medicare program that is based on the care preferences of selected patients with metastatic cancer (non small cell lung; pancreatic; biliary; and melanoma) and their families facing the end of life. Care preferences will be elicited using the Choosing Health Plans All Together (CHAT) methodology. This approach provides patients and family members with actuarially accurate cost tradeoffs of alternatives types of health care that could be chosen. All types of care cannot be afforded, so the decision is made under a scarcity constraint. The CHAT game approach begins with individual judgment of care preferences, and proceeds to two group based decision making rounds before concluding with a final individual assessment. The CHAT approach has been used successfully with Medicare beneficiaries. We will propose a new palliative care benefit using the patient and family preferences as the primary input, and will then simulate the expected cost of such a benefit were it implemented in Medicare, and compare it to the projected costs of the current Medicare hospice benefit. The goal of the project is to develop a palliative care benefit that will increase quality of life while minimizing health care costs.